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RPL (04-3813)77275 Calle Madrid 04-3813 Tlihf °F 4 Q" BUILDING & SAFETY DEPARTMENT P.O. BOX 1504 (760).777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . Property Address APN: Application description Property Zoning . . . Application valuation . . Owner GOLDEN WENDELL *NOT ON FILE UNKNOWN CA 99999 x=04-00003813 Date 4/30/04 •77275 CALLE MADRID 774-232-012-1 -000000- POOL - RESIDENTIAL COVE RESIDENTIAL -y 9800 Mid. Contractor KAV 4 2 ------------ 4 my OWNER/BUILDE -------y- - --1 -----------------------------------------------------------7---------------- Permit . . . . . . MECH POOL Additional desc . . Permit Fee 24.00 Plan Check Fee 6.00 Issue Date . . . . • Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 ---------------------------------------------------------------------------- Permit . . . . . . BLDG POOL PERMIT Additional desc Permit Fee . . . . 117.00 Plan Check Fee 76.05 Issue Date . . . . Valuation 9800 Qty Unit Charge Per Extension BASE FEE .45.00 8.00 9.0000 THOU BLDG 2,001-25,000 72.00 ---------------------------------------------------------------------------- Permit . . . . . . ELEC POOL PERMIT -RES Additional desc Permit Fee . . . . 45.00 Plan Check Fee 11.25 Issue Date . . Valuation . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00 ----------------7----------------------------------------------------------- Permit . . . . . PLUMBING Additional desc Permit Fee 33.00 Plan Check Fee 8.25 P.O. BOX 1504 • 444" VOICE (760) 777-7012 78-495 CALLE CALIFORNIAO FAX (760) 777-7011 LA QUINTA, IFOR92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 8y _. 3 Date: Applicant: I Architect or Engineer: Applicant's Mailing Address: C4;4Z4 -- Architect or Engineer's Address: Lic. No.. MUIL IJINU PLKMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. Lic aes-1 ate Contracter— OWNER-BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the 'M plicant to a civil penalty of not more than five hundred dollars ($500).): I as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec. , BA P.C. for this reason Date Owner CO WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Number certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date Applicant WARNING: FAILUR TO SECURE WORKERS' COMP SATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relafing to building construction, and hereby authorize representatives of this county to enter upon the above-menfioned property for inspection purposes. Date i L Signature (Applicant or Agent): Page 2 Application Number . . . . . 04-00003813 Date 4/30/04 Issue Date Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 6.0000 EA PLB FIXTURE 12.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 ---------------------------------------------------------------------------- 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 Special Notes and Comments POOL AND SPA ONLY. ALARMS BARRIERS SHALL BE IN PLACE PRIOR TO PREPLASTER INSPECTION. Fee summary ---------------- Charged Paid Credited Due Permit Fee ----------- Total 219.00 -------------------- .00 .00 ---------- 219.00 Plan Check Total 101.55 .00 .00 101.55 Grand Total 320.55 .00 .00 -320.55 ;1 T4'1 p 4 4 Q" Dear Property Owner: 78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 TELEPHONE (760) 777-7012 FAX (760) 777-7011 OWNER/BUILDER INFORMATION An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "Owner/ Builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the City or County. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the State and Federal Government as an employer,and you are subject to several obligations including State and Federal income tax withholding, federal social security taxes, worker's compensation insurance, disability insurance costs and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N. Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification.form so -that we can confitm..that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY 78495 Calle Tampico La Quinta, CA 92253 (760)777-7012 F(76 777-7011 OWNER'S IGNATURE/DATE PROPERTY ADDRESS o4-361 - 3 PERM NUMBER(s) PMOL Tj eau. BUILDING &SAFETY DEp1, APPROVED FOR. CONSTRUCTIO DATE . BY 7 17 7 C liG 7)lz ':TfUkCTOIR' flulw• Cr 0" PMG'M wpoidili an ING Not or dimir offvtoym we "G*ad to work of'wo* sn"l, thelowarm- Now =77 , WMIM &"A Off, 01 .. . ....... oF kA B -C -.duiMTA8u ....Oh Jot AWO ..crry va lom dtd J*iRM69 on Zhis lCo., AnY cKoWl 'to WO USI Mwr fm 4ppModty fftsu*ftolirietgejowvoc- .0d ng hent of bWdbv.owwA. For each vM*abkftW#. A torinadort 6elorrmaat s com fsie1AII1!!WflIIK ' rs"a4 IC-1t1a I*hb! a -it AL2 IC12 &Ist mate -sit - MAO MY 10-2if 0 L J 40A ao/fba) j) .0 0 L 3 . - R - Y. VIA WAGM-M . ififtl fh OW FWAL 194.0 PLOON" 4"1" QLAM M-lnVILA-AA 4 I UWAMOV. Ic4a COMM". I NWJIQ W34 :; 4AMOCAM.9 M -M Ix, K- r VR _ TWO < 3 ':TfUkCTOIR' flulw• Cr 0" PMG'M wpoidili an ING Not or dimir offvtoym we "G*ad to work of'wo* sn"l, thelowarm- Now =77 , WMIM &"A Off, 01 .. . ....... N I y r n f A=7 - POOL.. POOL 3 yr i A Rr-,.I_ - _/. - CITY OF LA QUINTA WILL BE CHARGED IF THE APP R ED BUILDING & SAFETY DEPT. PLANS AND JOB CARD ARE NOT ON APPROVED THE SITE FOR A SCHEDULED FOR CONST RUCTION INSPECTION. - S C j} j } ),Z i DAA BY NO EXCEPTIONS!